While recent years have seen a shift in care from hospitals to outpatient facilities like ambulatory surgery centers, inpatient services still account for about half of a hospital’s net patient revenue. Additionally, Medicare patients account for just under one-quarter of hospital payor days, on average. Understanding inpatient hospital stays is crucial for assessing patient populations, service line needs, and financial performance, and diagnosis-related groups (DRGs) make it easier to understand the details behind those stays.
DRG codes explained
Diagnosis-related groups are used to classify patients and document their hospital stay. Medicare sets a standard amount to pay for each hospital case and adds a payment weight for each DRG.
Medicare payment weights are based on several factors, including:
- Case severity
- Geographic location
- Proportion of low-income patients in the hospital’s service area
- Patient age, sex, and comorbidities
Healthcare providers and organizations selling into healthcare can track reimbursement volumes by DRG code to benchmark utilization and capacity, anticipate resource needs, and evaluate payor mix.
The Definitive Healthcare HospitalView product tracks Medicare inpatient DRGs for more than 5,800 U.S. hospitals. DRGs are sourced from the Medicare Standard Analytic Files (SAF).
How many DRGs are there?
The Definitive Healthcare HospitalView product includes hospitals billed for 762 DRGs through June 2025. The table below highlights the top DRG codes for Medicare inpatients through June 2025, based on estimated payments. The year-to-date Medicare data comes from the 2025 Medicare Quarterly SAF, which reflects approximately 93% claims maturity for each quarter.
Most common inpatient DRG codes (2025)
| Rank | DRG code | DRG description | Percent of total DRG diagnoses |
| 1 | 871 | SEPTICEMIA OR SEVERE SEPSIS W/O MV 96 OR MORE HOURS W MCC | 7.89% |
| 2 | 291 | HEART FAILURE & SHOCK W MCC | 4.08% |
| 3 | 193 | SIMPLE PNEUMONIA & PLEURISY W MCC | 2.63% |
| 4 | 885 | PSYCHOSES | 2.28% |
| 5 | 189 | PULMONARY EDEMA & RESPIRATORY FAILURE | 1.58% |
| 6 | 177 | RESPIRATORY INFECTIONS & INFLAMMATIONS W MCC | 1.50% |
| 7 | 872 | SEPTICEMIA OR SEVERE SEPSIS W/O MV 96 OR MORE HOURS W/O MCC | 1.34% |
| 8 | 690 | KIDNEY & URINARY TRACT INFECTIONS W/O MCC | 1.28% |
| 9 | 392 | ESOPHAGITIS, GASTROENT & MISC DIGEST DISORDERS W/O MCC | 1.21% |
| 10 | 057 | DEGENERATIVE NERVOUS SYSTEM DISORDERS W/O MCC | 1.21% |
Fig 1. Data from Definitive Healthcare HospitalView product and sourced from the Medicare Quarterly Standard Analytic Files (SAF) for calendar year 2025 through June. Accessed March 2026.
What are the top DRG codes of 2025?
DRG code 871 (septicemia or severe sepsis) leads with 7.89% of estimated payments, followed by DRG code 291 (heart failure and shock) at 4.08%. Other notable codes include DRG 885 (psychoses) at 2.28% and DRG 177 (respiratory infections and inflammations) at 1.5%. These top DRGs represent significant areas of inpatient care and can help identify trends in Medicare reimbursement.
Learn more
Want to explore more on hospitals, healthcare systems, and physician groups? Healthcare Insights are developed with data from the Definitive Healthcare product portfolio and from CMS. Want even more insights? Start a free trial now and get access to the latest intelligence on hospitals, physicians, and other healthcare providers.
You might also be interested in...
